Form 6 Form No /6

PERIODIC INSPECTION REPORT FOR AN ELECTRICAL INSTALLATION (note 1) (REQUIREMENTS FOR ELECTRICAL INSTALLATIONS - BS 7671 [IEE WIRING REGULATIONS])

DETAILS OF THE CLIENT

Client: .............................................................................................................................................................................

Address: ........................................................................................................................................................................

Purpose for which this Report is required: ..........................................................................................................(note 3)

DETAILS OF THE INSTALLATION Tick boxes as appropriate

Occupier: .......................................................................................................................................................................

Installation: ....................................................................................................................................................................

Address: ........................................................................................................................................................................

Description of Premises: Domestic Commercial Industrial Other

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Estimated age of the Electrical Installation:

....................... years

Evidence of ß¼¼·¬·±²­ ±® Alterations: Çes Òo Òot apparent

If "Yes", estimate age: .............................. years

Date of last inspection: .............................. Records available Yes No

EXTENT AND LIMITATIONS OF THE INSPECTION (note 5)

Extent of electrical installation covered by this report: ..................................................................................................

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Limitations: (see Regulation 634.2)....................................................................................................................................

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This inspection has been carried out in accordance with BS 7671:2008 (IEE Wiring Regulations), amended to ���.. Cables concealed within trunking and conduits, or cables and conduits concealed under floors, in roof spaces and generally within the fabric of the building or underground have not been inspected.

NEXT INSPECTION (note 8)

I/We recommend that this installation is further inspected and tested after an interval of not more than ............... §»¿®­ñ³±²¬̧ ­ô provided that any observations �requiring urgent attention� are attended to without delay.

DECLARATION

INSPECTED AND TESTED BY

Name: ........................................................................ Signature: ....................................................................

For and on behalf of: ................................................. Position: .......................................................................

Address: ....................................................................

.................................................................................... Date: ............................................................................

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SUPPLY CHARACTERISTICS AND EARTHING ARRANGEMENTS Tick boxes and enter details, as appropriate Earthing arrangements

TN-C TN-S TN-C-S TT IT

Alternative source of supply (to be detailed on attached schedules)

Number and Type of Live Conductors

a.c. d.c. 1-phase, 2-wire 2-pole 1-phase, 3 wire 3-pole 2-phase, 3-wire other 3-phase, 3-wire 3-phase, 4-wire

Nature of Supply Parameters

Nominal voltage, U/Uo(1) ....................... V

Nominal frequency, f (1) ........................ Hz Prospective fault current, Ipf

(2) .............. kA (note 4) External loop impedance, Ze

(2) ............. (Note: (1) by enquiry, (2) by enquiry or by measurement)

Supply Protective Device Characteristics

Type:................... ................... Rated current: ...............A

PARTICULARS OF INSTALLATION REFERRED TO IN THE REPORT Tick boxes and enter details, as appropriate Means of Earthing Details of Installation Earth Electrode (where applicable) Distributor�s facility Type Location Electrode resistance Installation earth electrode

(e.g. rod(s), tape etc) ................................

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to Earth ................................

Main Protective Conductors Earthing conductor: material ........................... csa ............................mm2 connection verified Main °®±¬»½¬·ª» bonding conduct±®­ material ........................... csa ............................mm2 connection verified

To incoming water service To incoming gas service To incoming oil service To structural steel To lightning protection To other incoming service(s) (state details..........................................................)

Main Switch or Circuit-breaker

BS, Type......................................... No. of poles ............ Current rating ............A Voltage rating ..................V

Location ........................................................................... Fuse rating or setting .............A

Rated residual operating current I n = .......... mA, and operating time of ....... ms (at I n) (applicable only where an RCD is suitable and is used as a main circuit-breaker)

OBSERVATIONS AND RECOMMENDATIONS Tick boxes as appropriate

(note 9) Recommendations as detailed below

Referring to the attached Schedule(s) of Inspections and Test Results, and subject to the limitations specified at the Extent and Limitations of the Inspection section

note 6

No remedial work is required The following observations are made:

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.......................... One of the following numbers, as appropriate, is to be allocated to each of the observations made above to indicate to the person(s) responsible for the installation the action recommended. 1 requires urgent attention 2 requires improvement 3 requires further investigation

4 does not comply with BS 7671:2008 amended to ��.� This does not imply that the electrical installation inspected is unsafe. SUMMARY OF THE INSPECTION (note 7) Date(s) of the inspection: ..................................................................................................................................................... General condition of the installation: ..................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... Overall assessment: Satisfactory/Unsatisfactory (note 8)SCHEDULE(S) The attached Schedules are part of this document and this Report is valid only when they are attached to it. ............ Schedules of Inspections and ............ Schedules of Test Results are attached. (Enter quantities of schedules attached).

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Form 3 Form No /3

SCHEDULE OF INSPECTIONS Methods of protection against electric shockBoth basic and fault protection:

(i) SELV (Note 1)

(ii) PELV

(iii) Double insulation (Note 2)

(iv) Reinforced insulation (Note 2)

Basic protection: (Note 3)

(i) Insulation of live parts

(ii) Barriers or enclosures

(iii) Obstacles (Note 4)

(iv) Placing out of reach (Note 5)

Fault protection: (i) Automatic disconnection of supply:

Presence of earthing conductor

Presence of circuit protective conductors

Presence of protective bonding conductors

Presence of supplementary bonding conductors

Presence of earthing arrangements for combined protective and functional purposes

Presence of adequate arrangements for alternative source(s), where applicable

FELV

Choice and setting of protective and monitoring devices (for fault and/or overcurrent protection)

(ii) Non-conducting location: (Note 6)

Absence of protective conductors

(iii) Earth-free local equipotential bonding: (Note 6)

Presence of earth-free local equipotential bonding

(iv) Electrical Separation: (Note 7)

Provided for one item of current-using equipment

Provided for more than one item of current-using equipment

Additional protection: Presence of residual current devices(s)

Presence of supplementary bonding conductors

Inspected by .............................................................

Prevention of mutual detrimental influence(a) Proximity of non-electrical services and other influences

(b) Segregation of Band I and Band II circuits or use of Band II insulation

(c) Segregation of safety circuits

Identification(a) Presence of diagrams, instructions, circuit charts and

similar information (b) Presence of danger notices and other warning notices (c) Labelling of protective devices, switches and terminals (d) Identification of conductors

Cables and conductors Selection of conductors for current-carrying capacity and

voltage drop

Erection methods

Routing of cables in prescribed zones

Cables incorporating earthed armour or sheath, or run within an earthed wiring system, or otherwise adequately protected against nails, screws and the like

Additional protection provided by 30 mA RCD for cables in concealed walls (where required in premises not under the supervision of a skilled or instructed person)

Connection of conductors

Presence of fire barriers, suitable seals and protection against thermal effects

General Presence and correct location of appropriate devices for

isolation and switching

Adequacy of access to switchgear and other equipment

Particular protective measures for special installations and locations

Connection of single-pole devices for protection or switching in line conductors only

Correct connection of accessories and equipment

Presence of undervoltage protective devices

Selection of equipment and protective measures appropriate to external influences

Selection of appropriate functional switching devices

Date .........................................................................

Notes: T to indicate an inspection has been carried out and the result is satisfactory

C to indicate an inspection has been carried out and the result is not satisfactory (applicable to a periodic inspection only) N/A to indicate the inspection is not applicable to a particular item LIM to indicate that, exceptionally, a limitation agreed with the person ordering the work prevented the inspection being carried out (applicable to a periodic inspection only). 6. Non-conducting locations and Earth-free local equipotential bonding

� these are not recognised for general application. May only be used where the installation is controlled/under the supervision of skilled or instructed persons (see Section 418)

7. Electrical separation � the particular requirements of the Regulations must be checked. If a single item of current-using equipment is supplied from a single source, see Section 413. If more than one item of current-using equipment is supplied from a single source then the installation must be controlled/under the supervision of skilled or instructed persons, see also Regulation 418.3ò

1. SELV � an extra-low voltage system which is electrically separated

from Earth and from other systems in such a way that a single-fault cannot give rise to the risk of electric shock. The particular requirements of the Regulations must be checked (see Section 414)

2. Double or reinforced insulation. Not suitable for domestic or similar installations if it is the sole protective measure (see 412.1.3)

3. Basic protection � will include measurement of distances where appropriate

4. Obstacles � only adopted in special circumstances (see 417.2) 5. Placing out of reach � only adopted in special circumstances

(see 417.3) Page of

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